In Denmark the number of cataract extractions has increased 350% from 1980 to 1991. During the same period the elderly population at risk has only increased 17%, and thus cannot account for the large increase in the number of extractions. In order to investigate whether more comprehensive clinical indications could be a possible explanation, we compared pre-operative visual acuity and visual impairment in two consecutive samples of Danish cataract surgery patients obtained in 1980 (n = 73) and in 1992 (n = 290). Criteria for inclusion were similar and both samples were representative for the whole country. During the period mean pre-operative visual acuity increased from 0.04 to 0.16 in the eye enlisted for surgery (p < 0.00001). Visual functional impairment could be compared by using the same questionnaire for patient interview in 1992 as was used in 1980. In 1992 the degree of impairment was significantly less for reading, outdoor orientation and self care activities. A change in surgical threshold or clinical indications for surgery appears to be a major contributing factor to the large increase in surgical rates, even though a trend to perform second eye cataract surgery more often might also be of some importance.